Infection of Healthcare Workers: Identifying Potential Transmission Pathways of MERS-CoV in Saudi Arabia Hospitals

Abstract

An outbreak of Middle East Respiratory Syndrome (MERS) among healthcare workers in Saudi Arabia in 2012 led to an investigation of hand-hygiene behaviors among healthcare professionals. Direct contact with patients is a major pathway for MERS, a droplet virus, which refers to a virus that lays on surfaces. This study investigated factors associated with respiratory disease transmission (e.g., MERS) in hospital settings among healthcare workers (i.e., physicians and nurses). I developed a 16-item checklist based on three sources: the CDC standards, the WHO Five Moments for Hand Hygiene, and Boyce and Pittet's (2002) guidelines of hand hygiene. I used those 16 items in both direct-observation and self-reported questionnaire formats. The checklist addressed three time frames of contact: before, during, and after contact with patients, devices, and surrounding surfaces. Hand-hygiene behaviors surrounding these time frames were assessed. The study also explored healthcare workers' beliefs about hygiene practices by comparing personal reports of hand hygiene assessed by questionnaire to observed actual hand-hygiene practices. The study was a cross-sectional research design and was conducted in the outpatient examination rooms and emergency departments of three hospitals (public, private, and military) in the Eastern region of Saudi Arabia. The total sample size included 87 physicians and nurses who were recruited while on duty during the researcher's observation periods. To provide clear results, I used two independent sample t-tests to test each of the 8 hypotheses. I found that no statistically significant differences were found among health-care workers when observing their behaviors of hand-hygiene practices. However, when using the self-reported questionnaire data, I found statistically significant differences between physicians' and nurses' hand-hygiene practices before, during, and after interacting with patients. Also, I found statistically significant differences between male and female hand-hygiene practices during interacting with patients, and I found statistically significant differences between health-care workers in public and military hospitals hand-hygiene practices during interacting with patients. For the primary hypothesis, I used Pearson correlation to determine the relationship between healthcare workers' reports of hand-hygiene practices, and observed healthcare workers behaviors of hand-hygiene practices. I found that no statistically significant correlation between the two data collection instruments. To provide a further analysis, a multivariate analysis of covariance (MANCOVA) was used to examine whether healthcare workers' hand-hygiene practices before, during, and after were different while controlling for their gender, department, and hospital type. I found that no statistically significant differences were found when observing the healthcare workers behaviors of hand-hygiene practices. However, when using the self-reported questionnaire data, I found that nurses and females reported better hand-hygiene than physicians and males. From these data, I conclude healthcare workers understand the importance of hand-hygiene and fail to appropriately implement the practice.